Siahpush and Singh Respond

Gessert’s critique complements our research. Whereas we emphasized social integration and structural explanations of the rural–urban disparities in suicide, Gessert suggests cultural explanations. Social structure and culture are intertwined. While some of the cultural values stated by Gessert may plausibly contribute to suicide rates, some may act as protective factors. For example, “emphasis on charity” can hardly be seen as leading to higher propensity to commit suicide. Similarly, distrusting government and authoritarianism may promote strong bonds and a cohesive subculture. A recent study of residents in disadvantaged communities suggests that in the face of exclusion from more affluent urban centers, they develop a strong sense of local identification and belonging and a feeling of pride in being able to cope with living in difficult conditions.1 The major message of our article was that rural–urban gradients in suicide mortality have been increasing. Gessert’s comments contribute to our understanding of the disparities in suicide mortality but do not explain why such disparities have been widening. Culture does not change as rapidly as economic and industrial structures or demographic forces, which, we contend, have contributed to changing patterns of rural–urban suicide disparity. The cultural factors listed by Gessert are not likely to have changed substantially in the past 3 decades and cannot be seen as affecting trends discussed in our article

Anomie · Commit · Criminology · Disadvantaged · Economic growth · Environmental health · Feeling · Government (linguistics) · Poison control · Political science · Pride · Sociology · Suicide prevention · Health disparities and outcomes · Medicine · Psychology · Social Psychology · Urban, Neighborhood, and Segregation Studies

• It's as if you’re locked in”

  Open Access•Miriam Stead, Susan Macaskill et al.•Health & Place•2001

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• Increasing Rural–Urban Gradients in US Suicide Mortality, 1970–1997

  Gopal K Singh, Mohammad Siahpush•American Journal of Public Health•2002

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• Zip Code Caveat

  Nancy Krieger, Pamela D Waterman et al.•American Journal of Public Health•2002

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• The Health Care Meanings, Values, and Practices of Anglo-American Males in the Rural Midwest

  Open Access•Sandra Courtney Seller, Sandra Courtney Sellers et al.•Journal of Transcultural Nursing•1999

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